=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649511973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESBURG INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2013
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 WILKENS AVENUE SUITE 302
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-722-0954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 WILKENS AVENUE SUITE 302
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-800-4572
-----------------------------------------------------
Fax | 410-286-1923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ABIOLA OBATUASE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 443-722-0954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------